Chair: Agreed in COW.
Iran: the capital accepts.
Chair: Agreed in COW.
OP6 and OP7
Chair: Agreed in COW.
Slovenia: Added addition of Australia to ‘prevention science’. Brackets on ‘adverse childhood experiences’ reservation by Venezuela but expressed flexibility. Tackle this first to remove the brackets.
Venezuela: We have asked for further explanation of this. Understand better and received help from UNODC and delegates. This is one form of prevention that is worth to work with. We don’t need to know much to know that every child who has adverse experiences needs special attention. This is used by WHO. This is just part of the prevention system as a whole. If delegation are willing that this is limited of the problem then we are willing to withdraw our reservation. But unfortunate to use something this important here. But you can remove reservation.
Iran: Please retain reservation on this environmental determinants term.
Russia: Our concern from Venezuela said this terminology is used by WHO and WHA. Now we try to bring to CND. Environmental determinants of health means in line with WHA resolution endorsed. Climate change, natural disasters and extreme events,…these are not the major factors that should be considered when talking about early prevention. These should be really taken into consideration. This means that do not fully understand the concepts of the social and environmental determinants of health. When I asked colleagues what means, persuaded has nothing to do with environment but when read WHA resolution was the case so I am cautious of using terminology which do not understand correctly. Proposal to replace social and environmental derminants of health ‘and other risk and protective factors’ instead. This would be also a broad definition which could encompass WHA and WHO concepts.
Egypt: it is very general terminology and comes from WHO. We don’t have any agreed language concerning social and environmental determinants. I think that the safe way is to have something that we might agree on in the CND. Concerning Russian proposal, have to examine it and I will get back to capital.
USA: surprised to hear reservations from MS who may not understand the term. This was introduced 3 weeks ago and bracketed since then so been opportunity to understand and USA provided resources to this language. Has been used in WHO context, aware of blending mandates or bringing over terms not understood, this is a very old term and been used repeatedly in WHO context. Fact not used in CND context doesn’t mean should close eyes to. We hear concern about environment determinants, we will be ok to remove this understanding how WHO efers to this term. Proposal to keep this language which is highly relevant familiar language and relevant to this resolution.
Venezuela: We have had also concerns on inclusion on terminology determinants of health because of same reasons. We have read what is it about and it is just one form of helping and not determinant of how to prevent. Add Venezuela in reservation. Since have concerns that this might narrow the scope, ‘addressing, inter alia’. UNODC explained the wording means and how its used. This is just part of what UNODC does in forms of prevention. If we mention this as part of the process then could work it out.
Australia: Social and environment determinants are just terminology in WHO I refer to INCB annual report chapter 1 item 35. Use of substance use increases due to environmental experiences. Colleagues from USA has demonstrate that those of us have used this terminology are willing to show a willingness to compromise on language. These are terms that have been used in INCB annual report. They are references in international standards and are references in number of resolutions. Some of members who are opposing this element of determinants of health have supported importance of standards in other resolutions. These are not just ideas. Constantly reference in the commission the importance of scientific based evidence. When it comes to what it tells us, seems to ignore that and suggest it is ideas. Have worked in prevention science and worked in government in developing it with WHO and UNODC. Strongly support that strong evidence based that for children early prevention must focus on social determinants of health. If do otherwise, will fail to have impact. It is based on scientific evidence base. Also used in INCB and WHO and standards. Not only focusing on one thing. Social determinants include family experiences, addressing family dysfunction, addressing vulnerability, ensuring children engaged in education, ensuring socioeconomic factors such as childhood experiences are included in broad range of strategies that are captured in the science and are supported by the science as an essential multifaceted approach to early prevention with children. It is scientific based evidence is supported by the documents and is related to this commission and UNODC. We recognize that environmental has caused challenges. We support the move by USA to compromise language, but is a step too far to ignore the scientific based evidence and ignore the previous docs been drawing on in development of this resolution.
UK: Thank you Australia. If going to be an expert group, then should listen to the experts. I listened intently to Australia and learnt from it. Strongly support Australian intervention. It is well grounded and can hear his expertise and we should all benefit from it.
Russia: Early prevention should be based in science. Have looked at WHO, UNODC international standards. This is document based on science and has been prepared by experts. You have failed to find references to social and environmental determinants of health. Not my own position, I am consulting experts from ministry of health from my country. There is no implementation of these concepts in our national system. Standards contain no references to it so cautious to use something that is not in standards. if expert consultation will take place, will be right place to discuss social determinants and other specific concepts related to this.
Germany: Fully Support US, Australia, UK. I also understand environmental determinant or what is said in the standards. this is similar concept and is very clear to us. Drug use is a health problem. There is a MOU between WHO and UNODC to tackle this problem. Don’t understand why hesitate to refuse to use this knowledge from WHO to support from the side of the CND to help people who use drugs, especially in prevention area need to be careful to take health aspects into account.
Slovenia: revisited this many times. For OP1, OP2, OP10. Propose language been introduced. Start after ‘adverse childhood experiences’. Say ‘as well as individual social and environmental risk and protective factors’ this was discussed already and seemed close to a compromise.
Venezuela: Ask Slovenia if they will keep in ‘inter ali’
USA: remain confused about the unwillingness to reference concepts used in Geneva. Also consulted with experts in health in USA. Last year, all experts in Geneva were able to agree to the concepts of social determinants of health. So confusing that some experts are unfamiliar with the terminology,. In spirit of compromise, we can get rid of ‘individual’. ‘Environmental’ could go with ‘community risk and protective factors’. If this acceptable, can keep the ‘inter alia’.
Slovenia: To answer Venezuela, no objection in keeping inter alia.
Russia: Our experts are familiar with the concept, but not applicable in the national system and should respect national approaches. Thank Slovenian colleague for proposal and brings us closer to a compromise. Why do we delete individual. Would like to keep individual and community risk and protective factors.
USA: not able to remove ‘social’. Could direct a question to UNODC of the importance of social and environment at this stage of development.
Chair: Ask rep of UNODC to clarify on this issue.
UNODC: True that term social determinant or environment determinant are not exactly reflected within prevention standards, but reflect that there are risk factors that are personal and individual level eg mental health, neurological development related to stress but these are interacting with micro level environmental level eg the family, school and peer influence. But also reflecting in int. standards. these macro level included income resources, social and physical environmental. These macro and micro structure interact with the individual. In other docs, what referred to macro level influences, eg economic stability, healthcare environment these are referred to a social determinants of health. The core content is focusing on individual of the person and how it reacts to the micro environment the family the school and community. How they interact with larger determinants of vulnerability that included poverty.
Australia: recognize that these are not familiar terms. The outcome doc on 2016 un general assembly item v5….the most pressing drug related socioeconomic factors, social marginalization….we are seeing this reference to social factors and in relation to children these are pressing factors that contribute to risk and they are critically important to address. Don’t want to go into a long list like earlier. Need a term that captures broad range of critical factors in early prevention. As UNODC said, these are commonly captured under the terms of social determinants and social and community factors. Australia is bemused that these terms are unfamiliar especially when there is reference to un general assembly. Hope to continue to work to ensure that continued to recognize that not just about individual its about poverty etc.